Changes in periodontal health in a cohort of British workers over a 14-year period.
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Biomedical subjects
Publications and source records attributed to F C Smales.
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In a previous study, a double-blind between subject comparison of the effects of metronidazole and placebo tablets was completed over 22 weeks in 45 subjects with chronic periodontal disease ranging in severity from moderate (PI = 2.0-3.9) to high (PI = 4.0-6.0). The results showed a significantly greater reduction in the mean probing depth of pockets with the use of metronidazole, but this reduction was apparent only in subjects with severe periodontal disease (PI = 4.0-6.0). 3 years later, 28 subjects attended. All groups still showed statistically significant improvements in all parameters when compared with those at the first visit. However, when compared with those at the end of the trial, there were statistically significant increases in gingival bleeding and calculus scores. An increase in plaque levels was also observed but this was not statistically significant. When subjects with moderate and severe periodontal disease were grouped together, there were no significant differences in any of the parameters between test and control groups. Moreover, the significantly greater reductions in mean probing depth of pockets, achieved with the use of metronidazole in the severe group at the end of the trial, had disappeared after 3 years. However, in subjects with mild disease, statistically significant reductions in pocket probing depth, not originally apparent, were observed 3 years later.
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The effect of plaque control on the apical microflora of deep periodontal pockets was studied. 8 subjects exhibiting signs of chronic periodontitis were chosen for the study, each subject having at least one pocket greater than 6 mm. These subjects were placed on a plaque control programme consisting of 3 visits, during which oral hygiene instructions were given. On two visits, the teeth of these subjects were scaled and polished. Bacteriological samples from the apex of a deep pockets from each subject were collected before the commencement of the plaque control programme and again at 8 and 16 weeks after the last scale and polish. No significant difference in the microbial flora was observed before and after plaque control, but marked fluctuation in bacterial composition was noted at the 3 samplings. It was concluded that supragingival plaque reduction was not sufficient to produce significant changes in the subgingival plaque composition of deep periodontal pockets.
A double blind between subject comparison of the effect of metronidazole and placebo tablets was completed over 22 weeks in 45 subjects with chronic periodontal disease ranging in severity from moderate (PI = 2.0-3.9) to high (PI = 4.0-6.0). All subjects used a topically applied chlorhexidine gel for the first 10 weeks. Throughout the trial plaque, bleeding and calculus were assessed on the buccal, lingual, mesial and distal surfaces of teeth 16, 21, 24, 36, 41 and 44 and their supporting tissues. The pocket depths on the same 4 aspects of all teeth present were measured. The regime employed consisted of oral hygiene instruction (OHI) at the initial visit followed by scaling and further OHI at visits 1 and 2 weeks later. After the third visit 16 X 200 mg metronidazole or placebo tablets were issued with instructions to take 1 that evening and 3 per day at 5-h intervals for the next 5 days. 4 weeks later, scaling and OHI were carried out and the course of test or placebo tablets was repeated. The subjects returned for further scaling and OHI 4 weeks later and the chlorhexidine gel was withdrawn. Final assessments were made 12 weeks later. The results showed that metronidazole had no effect on plaque levels and gingival bleeding beyond the effect of OHI, scaling and chlorhexidine gel. On the other hand, significantly greater reductions in pocket depths were achieved with the use of metronidazole. A surprising and interesting finding was that these reductions were apparent only in the subjects with severe periodontal disease (PI = 4.0-6.0).
Oral examinations were performed on 102 patients receiving immunosuppressive drug therapy following renal transplantation. A further 111 control patients matched for age and sex, were also examined. The severity of dental caries of the 2 groups was compared by considering their decayed, missing and filled teeth (DMF-T), and the severity of periodontal disease was compared in terms of pocket depths, Plaque, Calculus and Sulcular Bleeding Indices, and Russell's Periodontal Index. When comparing the 2 groups, note was made of restorations involving the gingival margins, the presence of partial dentures and recent and current antibiotic therapy. No significant differences were found between the groups with regard to age, sex distribution, plaque levels, DMF and Russell's Periodontal Index. The immunosuppressed group had significantly less calculus, fewer restorations involving the gingival margins and significantly lower mean pocket depth. However, they did have more gingival recession than the controls and also a higher Sulcus Bleeding Index. All differences seen were maintained even when patients from both groups on antibiotics were eliminated from the analysis. Within the immunosuppressed group no relationship was found between the length of time the drugs were taken and the periodontal variables. The study indicates that patients on immunosuppressive therapy show no change in susceptibility to destructive periodontal disease.
A new technique for the anaerobic sampling of deep periodontal pockets has been developed and evaluated in vitro and in vivo. The mean percentage difference of total viable counts from pairs of samples from nine deep periodontal pockets was found to be 76.4%. This compared favorably with an established technique for which the equivalent figure was 147.4%. Evidence was obtained that the first sample taken with the new sampler depleted the site. When correction was made for that effect, the mean percentage difference was found to be 31.1%. That value was in good agreement with the variation obtained by taking repeat samples from centrifuged deposits of pure cultures of bacteria.
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